Kassy Jo Fuller, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5664-12 Issued in WI

Practice address

2006 Progress Blvd
Antigo, WI 54409-2475

Phone

(715) 623-5481

NPI assigned

Jan 2, 2019

Last updated

May 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cornerstone Chiropractic of Antigo LLCGroup PAC ID 2163862152, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cornerstone Chiropractic of Antigo LLC

  • Chiropractor
  • Antigo, WI
  • NPI 1447030853
  Medicare reassignment Care Compare group NPD
• Cornerstone Chiropractic & Wellness LLC

  • Chiropractor
  • Shawano, WI
  • NPI 1841537701
  Medicare reassignment NPD
• Bowers Family Chiropractic

  • Rehabilitation Chiropractor
  • Edmonds, WA
  • NPI 1053516278
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715040000000",
    "number": "1316410368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 PROGRESS BLVD",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092475",
            "telephone_number": "715-623-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 PROGRESS BLVD",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092475",
            "telephone_number": "715-623-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "KASSY",
        "middle_name": "JO",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-02",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "60892858",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5664-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "60892858",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annika Grace Fox, M.S., CF-SLP
• Genda Sue Freeman, RD, CD
• Patrick William Frey, RPH
• Peter Scott Freyer, DDS
• Elizabeth Ann Friske, OTR,CHT
• Shelly A Gallenberg, PH.D.
• Brandon Gibson, DPT
• Loni Glatz, M.S. CCC-SLP
• Goldsworthy Chiropractic
• Bruce C Goldsworthy, DC

• Chiropractor in Antigo, WI
• Providers in Antigo, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.